Antepartum Fetal Assessment
A prenatal client in her second trimester is admitted to the maternity unit with painless, bright red vaginal bleeding. What test might the physician order? a. Alpha fetoprotein (AFP) b. Contraction stress test (CST) c. Amniocentesis d. Ultrasound
D ~ An ultrasound for placenta location to rule out placenta previa would be ordered for a client who presents with painless, bright red vaginal bleeding. Alpha fetoprotein (AFP) is a test used to screen for neural tube defects. A contraction stress test is ordered in the third trimester to evaluate the respiratory function of the placenta. Amniocentesis is a procedure used for genetic diagnosis or, in later pregnancy, for lung maturity studies.
What is the purpose of amniocentesis for a patient hospitalized at 34 weeks of gestation with pregnancy-induced hypertension? a. Determine if a metabolic disorder is genetic. b. Identify the sex of the fetus. c. Identify abnormal fetal cells. d. Determine fetal lung maturity.
D ~ During the third trimester, amniocentesis is most often performed to determine fetal lung maturity. In cases of pregnancy-induced hypertension, preterm birth may be necessary because of changes in placental perfusion. The test is done in the early portion of the pregnancy if the metabolic disorder is genetic. Amniocentesis is done early in the pregnancy to do genetic studies and determine the sex. Identification of abnormal cells is done during the early portion of the pregnancy.
Which should be considered a contraindication for transcervical chorionic villus sampling? a. Rh-negative mother b. Gestation less than 15 weeks c. Maternal age younger than 35 years d. Positive for group B Streptococcus
D ~ Maternal infection is a risk with this procedure, and it's contraindicated if the patient has an active infection in the cervix, vagina, or pelvic area. This procedure is done between 10 and 12 weeks. This procedure is usually done for women older than 35; however, if the woman is at high risk for fetal anomalies, her age is not a contraindication. The procedure can still be performed; however, Rh sensitization may occur if the mother is Rh-negative. Rho(D) immune globulin can be administered following the procedure.
A low-risk client calls the nurse at her prenatal office to report that she is not sure whether her baby has moved as much as usual today. What is the best response from the nurse? a. "Its normal for babies to move less as the pregnancy advances." b. "Go to the hospital for a nonstress test." c. "Pay attention to it for the rest of the day and call tomorrow if it's not back to normal." d. "Go lie on your side, count how many times the baby moves in the next 2 hours, and then call me back."
D ~ Ten fetal movements over a period of 2 hours is reassuring. If the client reports at least this much movement on her return call, no further assessment is necessary. If the client were calling with absent fetal movement or insufficient movement after counting, a nonstress test would be indicated. Maternal perception of fetal movement is a good indicator of fetal well-being, so reports of decreased movement should be followed up promptly.
What is the purpose of initiating contractions in a contraction stress test (CST)? a. Increase placental blood flow. b. Identify fetal acceleration patterns. c. Determine the degree of fetal activity. d. Apply a stressful stimulus to the fetus.
D ~ The CST involves recording the response of the fetal heart rate to stress induced by uterine contractions. The CST records the fetal response to stress. It does not increase placental blood flow. The NST looks at fetal heart accelerations with fetal movements. The NST and biophysical profiles look at fetal movements.
Which response by the nurse is most appropriate to the statement, "This test isn't my idea, but my husband insists?" a. It's your decision. b. Don't worry. Everything will be fine. c. Why don't you want to have this test? d. You're concerned about having this test?
D ~ The nurse should clarify the statement and assist the patient in exploring her feelings about the test. "It's your decision" is a closed statement and does not encourage the woman to express her feelings. Don't worry is false reassurance and does not deal with the concerns expressed by the woman. The woman may not be able to answer why questions. It may also make her defensive.
Which nursing intervention is necessary prior to a second-trimester transabdominal ultrasound? a. Perform an abdominal prep. b. Administer a soap suds enema. c. Ensure the client is NPO for 12 hours. d. Instruct the client to drink 1 to 2 quarts of water.
D ~ When the uterus is still in the pelvis, visualization may be difficult. It is necessary to perform the test when the woman has a full bladder, which provides a window through which the uterus and its contents can be viewed. An abdominal prep is not necessary for this procedure. A soap suds enema is not necessary for this procedure. The patient needs a full bladder to elevate the uterus; therefore, being NPO would not be appropriate.
On which aspect of fetal diagnostic testing do parents usually place the most importance? a. Safety of the fetus b. Duration of the test c. Cost of the procedure d. Physical discomfort caused by the procedure
A ~ Although all these are considerations, parents are usually most concerned about the safety of the fetus. Parents are concerned about the duration, but it is not the greatest concern. The cost of the procedure is important to parents, especially those without third-party payers, but is not the greatest concern. Discomfort of the procedure is important, especially for the mother, but is not the greatest concern.
A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. Scheduling an ultrasound is a standing prescription for the patient's health care provider. When is the best time for the nurse to schedule the patients ultrasound? a. Immediately b. In 2 weeks c. In 4 weeks d. In 6 weeks
A ~ An embryo can be seen about 5 to 6 weeks after the last menstrual period. At this time the crown-rump length (CRL) of the embryo is the most reliable measure of gestational age. Fetal viability is confirmed by observation of fetal heartbeat, which is visible when the CRL of the embryo is 5 mm.
The clinic nurse is obtaining a health history on a newly pregnant patient. Which is an indication for fetal diagnostic procedures if present in the health history? a. Maternal diabetes b. Weight gain of 25 lb c. Maternal age older than 30 d. Previous infant weighing more than 3000 g at birth
A ~ Diabetes is a risk factor in pregnancy because of possible impairment of placental perfusion. Excessive weight gain is an indication for testing. Normal weight gain is 25 to 35 lb. A maternal age older than 35 years is an indication for testing. Having had another infant weighing more than 4000 g is an indication for testing.
What does a score of 9 on a biophysical profile signify? a. Normal b. Abnormal c. Equivocal d. Nonreactive
A ~ Five parameters of fetal activity: 1) fetal heart rate 2) fetal breathing movements 3) gross fetal movements 4) fetal tone 5) amniotic fluid volume .. are used to determine the biophysical profile. The maximum score is 2 points for each parameter. A score falling between 8 and 10 is considered normal. A score of 4 or less is considered abnormal. Equivocal and nonreactive are not terms used to describe the results of a biophysical profile.
When is the most accurate time to determine gestational age through ultrasound? a. First trimester b. Second trimester c. Third trimester d. No difference in accuracy among the trimesters
A ~ Gestational age determination by ultrasonography is increasingly less accurate after the first trimester. Gestational age determination is best done in the first trimester. There is a difference in trimesters when doing a gestational age ultrasonography.
The results of a contraction stress test (CST) are positive. Which intervention is necessary based on this test result? a. Repeat the test in 1 week so that results can be trended based on this baseline result. b. Contact the health care provider to discuss birth options for the patient. c. Send the patient out for a meal and repeat the test to confirm that the results are valid. d. Ask the patient to perform a fetal kick count assessment for the next 30 minutes and then reassess the patient.
B ~ A positive CST test is an abnormal finding & the physician should be notified so that birth options can be initiated. A positive CST indicates possible fetal compromise. Intervention should not be delayed by 1 week and results do not have to be trended. Because this is an abnormal result, there is no need to repeat the test. Sending the patient out for a meal will delay treatment options and may interfere with possible birth interventions if anesthesia is needed. Fetal kick count assessment is not needed at this time and will further delay treatment interventions for this abnormal result, which indicates fetal compromise.
What does nursing care after amniocentesis include? a. Forcing fluids by mouth b. Monitoring uterine activity c. Placing the client in a supine position for 2 hours d. Applying a pressure dressing to the puncture site
B ~ A risk with amniocentesis is the onset of spontaneous contractions. Hydration is important, but the woman has not been NPO, so this should not be a problem. The supine position may decrease uterine blood flow; the side-lying position is preferred. Pressure dressings are not necessary.
A pregnant patient has received the results of her triple-screen testing and it is positive. She provides you with a copy of the test results that she obtained from the lab. What would the nurse anticipate as being implemented in the patient's plan of care? a. No further testing is indicated at this time because results are normal. b. Refer to the physician for additional testing. c. Validate the results with the lab facility. d. Repeat the test in 2 weeks and have the patient return for her regularly scheduled prenatal visit.
B ~ Additional genetic testing is indicated to provide the patient with treatment options. A positive result on a triple-screen test is considered to be an abnormal finding so the patient should be referred to the physician for additional genetic testing. Validation of the test with a lab facility is not necessary because the patient provided you with a copy of the test results. There is no need to repeat the clinical test because the findings have already been determined.
A prenatal client at 30 weeks' gestation is scheduled for an amniocentesis to determine fetal lung maturity. The nurse expects the lecithin/sphingomyelin (L/S) ratio to be: a. 0.5:1. b. 1:1. c. 2:1. d. 3:1.
B ~ At about 30-32 weeks' gestation, the amounts of lecithin and sphingomyelin become equal, an L/S ratio of 1:1. Prior to 30 weeks' gestation, the lecithin concentration is less than that of the sphingomyelin (L/S ratio of 0.5:1). After 35 weeks, the lecithin exceeds the sphingomyelin by a ratio of 2:1 or greater.
For which patient would an L/S ratio of 2:1 potentially be considered to be abnormal? a. A 38-year-old gravida 2, para 1, who is 38 weeks gestation b. A 24-year-old gravida 1, para 0, who has diabetes c. A 44-year-old gravida 6, para 5, who is at term d. An 18-year-old gravida 1, para 0, who is in early labor at term
B ~ Even though an L/S ratio of 2:1 is typically considered to be a normal finding to validate fetal lung maturity prior to 38 weeks gestation, the result may not be accurate in determining fetal lung maturity if a patient is diabetic.
The nurse is counseling a healthy, 22-year-old G1P0 at 8 weeks' gestation about routine prenatal testing. Which tests should the nurse expect to discuss? a. Amniocentesis b. First-trimester combined screening c. Cell-free DNA d. Fetal echocardiogram
B ~ First-trimester combined screening is recommended for all women to rule out the need for diagnostic testing for aneuploidy. Amniocentesis may be used to follow up abnormal screening tests, but would not be done routinely for a woman under 35 without risk factors. Cell-free DNA is currently offered to women over 35. A fetal echocardiogram is an ultrasound examination of the fetal heart to rule out congenital defects in the presence of risk factors or abnormal preliminary tests.
The nurse is reviewing the procedure for alpha-fetoprotein (AFP) screening with a patient at 16 weeks gestation. The nurse determines that the patient understands the teaching when she mentions that which fluid will be collected for the initial screening process? a. Urine b. Blood c. Saliva d. Amniotic
B ~ Initial screening is completed with blood. AFP can be detected in amniotic fluid; however, that procedure is more costly and invasive. Procedures progress from least invasive to most invasive.
Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Biophysical profile b. Multiple-marker screening c. Lecithin-to-sphingomyelin ratio d. Blood type and crossmatch of maternal and fetal serum
B ~ Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), inhibin A, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus. The biophysical profile is used to evaluate fetal status during the antepartum period. Five variables are used, but none are concerned with chromosomal problems. The lecithin-to-sphingomyelin ratio is used to determine fetal lung maturity. The blood type and crossmatch will not predict chromosomal defects in the fetus.
Which complication could occur as a result of percutaneous umbilical blood sampling (PUBS)? a. Postdates pregnancy b. Fetal bradycardia c. Placenta previa d. Uterine rupture
B ~ PUBS is an invasive test whereby a needle is inserted into the umbilical cord to obtain blood as the basis for diagnostic testing with the guidance of ultrasound technology. The most common complication is fetal bradycardia, which is temporary. PUBS has no effect on extending the gestation of pregnancy, the development of placenta previa, or uterine rupture.
Which factor serves as a clinical indicator for a third trimester amniocentesis? a. Sex of the fetus b. Rh isoimmunization c. Placenta previa d. Placental abruption
B ~ Rh isoimmunization is a clinical indicator for a third-trimester amniocentesis. Although an amniocentesis can determine the sex of the fetus, this is not a primary indication for a third-trimester amniocentesis. Ultrasound imaging would be indicated for evaluation of placenta previa. Ultrasound imaging would be indicated for evaluation of placental abruption.
A client in her third trimester has come to the clinic for her first prenatal visit. She asks the nurse whether ultrasound can determine the baby's age. What statement by the nurse would be the best response? a. "The accuracy of ultrasound is the same in the first and third trimesters." b. "The estimate of gestational age may vary by 1-3 weeks." c. "A comprehensive ultrasound is needed for accuracy." d. "The ultrasound measures gender, not age."
B ~ The ability to establish fetal age accurately by ultrasound is lost in the third trimester because fetal growth is not as uniform as it is in the first two trimesters; however, ultrasound can be used to approximate gestational age within 1-3 weeks' accuracy during the third trimester. A comprehensive ultrasound is used to detect anatomical defects, not gestational age. Ultrasound is not used to determine gender.
A biophysical profile is performed on a pregnant patient. The following assessments are noted: nonreactive stress test (NST), three episodes of fetal breathing movements (FBMs), limited gross movements, opening and closing of hang indicating the presence of fetal tone, and adequate amniotic fluid index (AFI) meeting criteria. What would be the correct interpretation of this test result? a. A score of 10 would indicate that the results are equivocal. b. A score of 8 would indicate normal results. c. A score of 6 would indicate that birth should be considered as a possible treatment option. d. A score of 9 would indicate reassurance.
B ~ The biophysical profile is used to assess fetal well-being. Five categories of assessment are used in this combination test: fetal monitoring NST, evaluation of FBMs, gross movements, fetal tone, and calculation of the amniotic fluid index (AFI). A maximum of 2 points is used if criteria are met successfully in each category; thus a score in the range of 8 to 10 indicates a normal or reassuring finding. A score of 6 provides equivocal results and further testing or observation is necessary. A score of 4 or less requires immediate intervention, and birth may be warranted. The provided assessments indicate a score of 8 as the only area that has not met the stated criteria in the NST.
The nurse's role in diagnostic testing is to provide which of the following? a. Advice to the couple b. Information about the tests c. Reassurance about fetal safety d. Assistance with decision making
B ~ The nurse should provide the couple with all necessary information about a procedure so that the couple can make an informed decision. The nurse's role is to inform, not to advise. Ensuring fetal safety is not possible with all the diagnostic tests. To offer this is to give false reassurance to the parents. The nurse can inform the couple about potential problems so they can make an informed decision. Decision making should always lie with the couple involved. The nurse should provide information so that the couple can make an informed decision.
A woman who is 36 weeks pregnant asks the nurse to explain the vibroacoustic stimulator (VAS) test. Which should the nurse include in the response? (SATA) a. The test is invasive. b. The test uses sound to elicit fetal movements. c. The test may confirm nonreactive nonstress test results. d. The test can only be performed if contractions are present. e. Vibroacoustic stimulation can be repeated at 1-minute intervals up to three times.
B, C, E ~ Also referred to as VAS or acoustic stimulation, the vibroacoustic stimulator (similar to an electronic larynx) is applied to the maternal abdomen over the area of the fetal head. Vibration and sound are emitted for up to 3 seconds and may be repeated. A fetus near term responds by increasing the number of gross body movements, which can be easily seen and felt. The procedure can confirm reassuring NST findings and shorten the length of time necessary to obtain NST data. The test is noninvasive and contractions do not need to be present to perform the test.
When is the earliest that chorionic villus sampling can be performed during pregnancy? a. 4 weeks b. 8 weeks c. 10 weeks d. 12 weeks
C ~ Fetal villus tissue can be obtained as early as 10 weeks of gestation and can be analyzed directly for chromosomal or genetic abnormalities. It is too early to be performed at 4 weeks. It is too early to be performed at 8 weeks. The test should be performed at 12 weeks, but it can be done as early as 10 weeks.
Which is the major advantage of chorionic villus sampling over amniocentesis? a. It is not an invasive procedure. b. It does not require a hospital setting. c. It requires less time to obtain results. d. It has less risk of spontaneous abortion.
C ~ Results from chorionic villus sampling can be known within 24 to 48 hours, whereas results from amniocentesis require 2 to 4 weeks. It is an invasive procedure. The woman has to be in a hospital setting for her and the fetus to be properly assessed during and after the procedure. The risk of an abortion is at the same level for both procedures.
What is the term for a nonstress test in which there are two or more fetal heart rate accelerations of 15 or more bpm with fetal movement in a 20-minute period? a. Positive b. Negative c. Reactive d. Nonreactive
C ~ The nonstress test (NST) is reactive (normal) when there are two or more fetal heart rate accelerations of at least 15 bpm (each with a duration of at least 15 seconds) in a 20-minute period. A positive result is not used with an NST. The contraction stress test (CST) uses positive as a result term. A negative result is not used with an NST. The CST uses negative as a result term. A nonreactive result means that the heart rate did not accelerate during fetal movement.
In preparing a pregnant patient for a nonstress test (NST), which of the following should be included in the plan of care? a. Have the patient void prior to being placed on the fetal monitor because a full bladder will interfere with results. b. Maintain NPO status prior to testing. c. Position the patient for comfort, adjusting the tocotransducer belt to locate fetal heart rate. d. Have an infusion pump prepared with oxytocin per protocol for evaluation.
C ~ The nurse must adjust the tocotransducer to find the best location to pick up and record the fetal heart rate. Positioning the patient for comfort during testing is a prime concern. Although a full bladder may affect client comfort, it will not interfere with testing results. NPO status is not required for an NST. Instead, a pregnant patient should maintain her normal nutritional intake to provide energy to herself and the fetus. An infusion pump with oxytocin is required for a contraction stress test (CST).
The nurse is preparing a patient for a nonstress test (NST). Which interventions should the nurse plan to implement? (SATA) a. Ensure that the client has a full bladder. b. Plan approximately 15 minutes for the test. c. Have the client sit in a recliner with the head elevated 45 degrees. d. Apply electronic monitoring equipment to the clients abdomen. e. Instruct the client to press an event marker every time she feels fetal movement.
C, D, E ~ The patient may be seated in a reclining chair or have her head elevated at least 45 degrees. The nurse applies external electronic monitoring equipment to the patient's abdomen to detect the fetal heart rate and any contractions. The woman may be given an event marker to press each time she senses movement. Before the NST, the patient should void and her baseline vital signs should be taken. The NST takes about 40 minutes, allowing for most fetal sleep-wake cycles, although the fetus may show a reassuring pattern more quickly or need more time to awaken and become active. Fifteen minutes would not allow enough time to complete the test.
A patient at 36 weeks gestation is undergoing a nonstress (NST) test. The nurse observes the fetal heart rate baseline at 135 beats per minute (bpm) and four nonepisodic patterns of the fetal heart rate reaching 160 bpm for periods of 20 to 25 seconds each. How will the nurse record these findings? a. NST positive, nonreassuring b. NST negative, reassuring c. NST reactive, reassuring d. NST nonreactive, nonreassuring
C ~ The presence of at least three accelerations of at least 15 beats, over at least 15 seconds, over a duration of at least 20 minutes, is considered reactive and reassuring. Nonreactive testing reveals no or fewer accelerations over the same or longer period. The NST test is not recorded as positive or negative.
The nurse is teaching a prenatal client about chorionic villus sampling (CVS). The nurse correctly teaches the client that the risks associated with CVS include: (SATA) a. Intrauterine infection. b. Rupture of membranes. c. Maternal hypertension. d. Spontaneous abortion.
A, B, D ~ Risks of CVS include intrauterine infection, rupture of membranes, and spontaneous abortions, as well as Rh isoimmunization and fetal limb defects.
The nurse is reviewing four prenatal charts. Which client would be an appropriate candidate for a contraction stress test (CST)? a. A client with a nonreactive NST b. A client with multiple gestation c. A client with an incompetent cervix d. A client with placenta previa
A ~ Fetal well-being can be confirmed by a CST after a nonreactive or equivocal nonstress test. The contraction stress test is contraindicated for the client with multiple gestation, an incompetent cervix, or placenta previa.
A pregnant patient's biophysical profile score is 8. She asks the nurse to explain the results. What is the nurse's best response? a. The test results are within normal limits. b. Immediate birth by cesarean birth is being considered. c. Further testing will be performed to determine the meaning of this score. d. An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding birth.
A ~ The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Birth can be delayed if fetal well-being is an issue. Scores less than 4 would be investigated, and birth could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed.
The nurse is reviewing maternal serum alpha-fetoprotein (MSAFP) results. Which conditions are associated with elevated levels of MSAFP? (SATA) a. Fetal demise b. Neural tube defects c. Abdominal wall defects d. Chromosomal trisomies e. Gestational trophoblastic disease
A, B, C ~ Elevated levels of AFP may indicate open neural tube defects (e.g., anencephaly, spina bifida), abdominal wall defects (e.g., omphalocele, gastroschisis), or fetal demise. Low levels of AFP may indicate chromosomal trisomies (e.g., Down syndrome, trisomy 21) or gestational trophoblastic disease.
Transvaginal ultrasonography is often performed during the first trimester. A 6-week-gestation patient expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be necessary to determine which of the following? (SATA) a. Multifetal gestation b. Bicornuate uterus c. Presence and location of pregnancy d. Amniotic fluid volume e. Presence of ovarian cysts
A, B, C, E ~ A bicornuate uterus, multifetal gestation, presence of ovarian cysts, and presence and location of pregnancy can be determined by transvaginal ultrasound in the first trimester of pregnancy. This procedure is also used for estimating gestational age, confirming fetal viability, identifying fetal abnormalities or chromosomal defects, and identifying the maternal abnormalities mentioned, as well as fibroids. Amniotic fluid volume is assessed during the second and third trimesters. Conventional ultrasound would be used.
The nurse is instructing a patient on how to perform kick counts. Which information should the nurse include in the teaching session? (SATA) a. Use a clock or timer when performing kick counts. b. Your bladder should be full before performing kick counts. c. Notify your health care provider if you have not felt movement in 24 hours. d. Protocols can provide a structured timetable for concentrating on fetal movements. e. You should lie on your side, place your hands on the largest part of the abdomen, and concentrate on the number of movements felt.
A, D, E ~ The nurse should instruct the patient to lie on her side, place her hands on the largest part of her abdomen, and concentrate on fetal movements. She should use a clock or timer and record the number of movements felt during that time. Protocols are not essential but may give the patient a more structured timetable for when to concentrate on fetal movements. The bladder does not need to be full for kick counts; it is better to have the patient empty her bladder before beginning the assessment of fetal movements. Further evaluation is recommended if the patient feels no movements in 12 hours; 24 hours is too long before notifying the health care provider.
A prenatal client at 30 weeks' gestation is scheduled for a nonstress test (NST) and asks the nurse, "What is this test for?" The nurse correctly responds that the test is used to identify: (Select all that apply.) a. Fetal lung maturity. b. Adequate fetal oxygenation. c. Accelerations of fetal heart rate. d. Fetal well-being.
B ~ An NST documents fetal well-being by measuring fetal oxygenation and fetal heart rate accelerations, but not fetal lung maturity.
The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine whether the fetus has which? a. Hemophilia b. Sickle cell anemia c. A neural tube defect d. A normal lecithin-to-sphingomyelin ratio
C ~ An open neural tube allows a high level of AFP to seep into the amniotic fluid and enter the maternal serum. Hemophilia is a genetic defect and is best detected with chromosomal studies, such as chorionic villus sampling or amniocentesis. Sickle cell anemia is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. L/S ratios are determined with an amniocentesis and are usually done in the third trimester.
A client at 28 weeks' gestation is admitted to the labor and birth unit for observation after a motor vehicle crash. Which test might be used to assess the client's fetal status? a. Ultrasound for physical structure b. Contraction stress test (CST) c. Biophysical profile (BPP) d. Amniocentesis
C ~ Biophysical profile would be used to assess the client's fetal status at 28 weeks' gestation. Ultrasound for physical structure is limited to identifying the growth and development of the fetus, and does not assess for other parameters of fetal well-being. Contraction stress test is appropriate in the third trimester. Amniocentesis tests for lung maturity, not overall status.
A pregnant woman is scheduled to undergo chorionic villus sampling (CVS) based on genetic family history. Which medication does the nurse anticipate will be administered? a. Magnesium sulfate b. Prostaglandin suppository c. RhoGAM if the client is Rh-negative d. Betamethasone
C ~ CVS can increase the likelihood of Rh sensitization if a woman in Rh-negative. There is no indication for magnesium sulfate because it is used to stop preterm labor. There is no indication for administration of a prostaglandin suppository. Betamethasone is given to pregnant women in preterm labor to improve fetal lung maturity.
The physician orders an ultrasound for a prenatal client prior to an amniocentesis. The nurse explains to the client that the purpose of the ultrasound is to: a. Determine the gestational sac volume. b. Measure the fetus's crown-rump length. c. Locate the placenta. d. Measure the fetus's biparietal diameter.
C ~ The purpose of the ultrasound before an amniocentesis is to locate the placenta, fetus, and an adequate pocket of fluid. Determination of the gestational sac volume, measuring the crown-rump length, and measuring the biparietal diameter are aspects of assessing fetal well-being (biophysical profile, or BPP), and may or may not be done prior to the amniocentesis, depending on gestational age.
Which clinical conditions are associated with increased levels of alpha fetoprotein (AFP)? (SATA) a. Down syndrome b. Molar pregnancy c. Twin gestation d. Incorrect gestational age assessment of a normal fetus estimation is earlier in the pregnancy e. Threatened abortion
C, D, E ~ Elevated APF levels are seen in multiple gestations, underestimation of fetal age, and threatened abortion. Decreased levels are seen in Down syndrome and a molar pregnancy.
The nurse is preparing a prenatal client for a transvaginal ultrasound. What nursing action should be included in the preparations? a. Advise the client not to empty her bladder. b. Encourage the client to drink 1.5 quarts of fluid. c. Apply transmission gel over the client's abdomen. d. Place the client in lithotomy position.
D ~ After having the client void, assist her to a lithotomy position for a transvaginal ultrasound. Preparation for a transabdominal ultrasound includes encouraging the client to drink 1.5 quarts of fluid, maintaining a full bladder, and applying transmission gel over the client's abdomen.
A prenatal client at 22 weeks' gestation is scheduled for an amniocentesis. What would be an appropriate nursing action to prepare this client for the procedure? a. Cleanse the client's abdominal skin with alcohol. b. Administer Rh immune globulin to the client. c. Encourage the client to take fluids. d. Position the client in a left lateral tilt.
D ~ An appropriate nursing action to prepare this client for amniocentesis would be to position the client in a left lateral tilt to prevent supine hypotension. The skin is cleansed with povidone-iodine (Betadine), not alcohol. Rh immune globulin is appropriate only for nonsensitized Rh-negative women after the procedure. Encouraging the client to take fluids is not appropriate prior to the procedure, because the client may become nauseated.
